Mizoram Health Insurance Scheme

The initiation of the Mizoram State Health Care Scheme (MSHCS) by the government of Mizoram in April 2008 marked a big step towards enhancing access to medical treatment, particularly for ailments necessitating hospitalisation and surgery.

With a health insurance cover extending up to ₹2 lakh under MSHCS and ₹3 lakh when clubbed with Rashtriya Swasthya Bima Yojana, its fundamental objective was to alleviate financial burdens associated with healthcare expenses. Initially established through a public-private partnership involving the Mizoram government, an insurance entity, a third-party administrator, and a network of accredited hospitals, the scheme encountered discontent and scepticism owing to perceived indifference and rigidity on the part of insurance providers in addressing claims.

Consequently, since 2011, the healthcare scheme in Mizoram has transitioned to a self-financed model. The Mizoram State Health Care Society oversees the scheme's implementation across the state and has been administering the Rashtriya Swasthya Bima Yojana (RSBY Mizoram) under the ambit of MSHCS since 2010.

Targeting primarily individuals lacking health insurance coverage, the scheme addresses the pressing need to mitigate financial barriers hindering access to essential healthcare services. Prior to the inception of the Mizoram healthcare scheme, vulnerable populations often resorted to borrowing, asset liquidation, or avoiding medical treatment altogether, underscoring the scheme's significance in ameliorating financial obstacles to primary healthcare access.

• Ration card

• Voter ID card belonging to the head of the family

• Aadhaar card

Below are the detailed benefits of the Mizoram Health Insurance Scheme (PMJAY Mizoram)

Pre- and Post-Hospitalisation Cover:

The scheme provides pre-hospitalisation cover of up to 1 day before admission and post-hospitalisation cover of up to 10 days after discharge. Pre-hospitalisation coverage includes related investigations and is not limited to the 1-day period. For organ transplantation patients, post-hospitalisation coverage extends to 30 days.

Maternity and Newborn Child:

BPL families can obtain maternity coverage, and medical expenses for newborn children are covered for both APL and BPL families.

Day Care Procedures:

The Mizoram Health Insurance Scheme covers various daycare (OP) services, including dialysis, hepatitis B & C treatment, drug-resistant TB treatment, hysterectomy, epilepsy treatment, radiotherapy, parenteral chemotherapy, eye surgery, ear-nose-throat surgery, lithotripsy, laparoscopic therapeutic surgeries, dental surgery following an accident, surgeries under general anaesthesia, treatment of fractures/dislocations (excluding hairline fractures), and minor reconstructive operations of limbs requiring hospitalisation.

Critical Illness:

The scheme covers specific critical illnesses. BPL families can claim up to Rs. 2 lakh for critical illnesses, in addition to Rs. 70,000 and RSBY coverage for hospitalisation expenses. APL families are eligible for coverage of up to Rs. 3 lakh for critical illnesses.

Coverage of Pre-Existing Diseases:

• All pre-existing diseases covered by the scheme are included from the day of enrollment.

• Travel Allowance

• Travel expenses are covered with a maximum of ₹1,000 within the state and ₹10,000 per claim outside the state.

Exclusions of Mizoram Health Insurance Scheme

• There are certain circumstances under which individuals may not be eligible to apply for the Mizoram State Health Care Scheme. These exclusions are:

• Costs associated with spectacles, contact lenses, and hearing aids are not covered.

• The scheme does not cover intentional self-injury.

• Vaccinations are not included in the coverage.

• Unless prescribed for treatment purposes, vitamins or tonics are not encompassed within the Mizoram Health Insurance Scheme.

• Patients with medical conditions that do not necessitate hospitalisation are not covered for daycare procedures.

• Dental treatment or surgery is excluded unless it results in hospitalisation.

• Surgeries performed for cosmetic or aesthetic purposes are excluded unless deemed necessary due to an accident or illness.

The registration fees are significant in the processing of claims within Mizorm's healthcare scheme. Below are the respective fees required from various categories of beneficiaries:

Here are the comprehensive steps to register for the insurance scheme under the Mizoram Health Care Society:

Step 01: Collect the necessary identification proofs, which typically include your voter ID card, ration card, and BPL card if applicable.

Step 02: Head to the nearest health sub-centre in your area where registrations for the insurance scheme are being conducted.

Step 03: Upon arrival at the health sub-centre, proceed to pay the registration fee as required. Ensure to carry sufficient funds for this purpose.

Step 04: Present the voter ID card of the head of your family for identity verification purposes. This step is significant to confirm your eligibility for enrollment in the scheme.

Step 05: Once your identity is verified and the registration fee is paid, the officials will proceed to issue a laminated photo ID card to you. This MHIS identity card serves as proof of your enrollment in the insurance scheme and provides access to the benefits offered.

By diligently following the above mentioned steps, you can successfully register for the insurance scheme administered by the Mizoram Health Care Society, ensuring access to essential healthcare coverage for you and your family.

While MHIS provides medical facilities to the underprivileged sections of society in Mizoram, individuals not covered under the scheme can still secure a mediclaim policy for themselves and their families in the state.

With Tata AIG, you can select from a range of individual and family floater medical insurance plans, each offering numerous benefits, such as cashless hospitalisation, tax advantages, and pre- and post-hospitalisation coverage.

Various insurance plans, including critical illness, elder care, and dental insurance in India, cater to diverse individual needs. Tata AIG's health insurance plan encompasses hospitalisation coverage, in-patient treatment, daycare procedures, and more.

When purchasing a health insurance policy, it is essential to assess the coverage and premium carefully. Additionally, individuals can enhance their protection by opting for add-ons.

Through our cashless medical insurance facility, policyholders can conveniently access medical services at their preferred hospitals without incurring out-of-pocket expenses.

Throughout this blog, we have delved into the comprehensive coverage provided by the scheme, offering up to Rs. 3 lakh in insurance coverage to some of the most vulnerable families in Mizoram.

Through initiatives like MHIS, Mizoram is forging ahead on the path to universal healthcare, ensuring that its citizens receive quality medical care without being weighed down by financial constraints.

By prioritising access to essential healthcare services and providing financial protection to those in need, the Mizoram Health Insurance Scheme exemplifies the government's commitment to endorsing the health and welfare of its populace.

As the scheme continues to evolve and expand, it promises to foster healthier communities and a brighter future for all Mizoram residents.

Who is eligible for Ayushman Bharat?

To be eligible for an Ayushman Bharat Card 2024, your annual income must not exceed Rs 2.5 lakh. Additionally, your family should not have any members earning above the age of 16.

Furthermore, if you are in the SC or ST category, you can register online for this scheme. Even if you lack permanent residency, you are eligible to apply for the Ayushman Yojana and obtain this health card.

What is the Pradhan Mantri 5 lakh medical scheme?

Ayushman Bharat PMJAY stands as the world's largest health assurance scheme, striving to offer health coverage of Rs. 5 lakhs annually per family for secondary and tertiary care hospitalisation.

Who is eligible for the golden card?

Within the PMJAY Urban scheme, eligibility for the PMJAY Golden Card extends to individuals in the following categories:

• Ragpickers

• Transport workers, conductors, cart pullers

• Washermen, chowkidars, construction workers, coolies, labourers

• Domestic workers

• Beggars

• Servers, shop workers, delivery assistants

• Mechanics, masons, plumbers, electricians

• Hawkers, street vendors, cobblers